Wednesday, September 30, 2015

Couples who come to us for infertility treatment want answers; in some instances this could be their first visit to an IVF clinic, while at others they may have gone to various other clinics, been unsuccessful in getting pregnant, and will have come to us. Regardless of which category they fall in, they all want answers ! The first question is the most basic one - What is causing our infertility?

I tell them very candidly that we can’t always provide them with an answer to what seems to be a simple question, even though we do have the skills and technology to treat it in the best possible way.

What makes the unexplained infertility reason so puzzling for patients is that they expect IVF specialists to have all the answers because we are the medical experts. However, now we are saying that we can’t pinpoint the problem! Patients are understandably frustrated with this “non-diagnosis” because from their point of view, it’s a dead end. The good news is that this is not true, because even though we are not good at identifying problems , we are good at bypassing them !

The Facts

•The first question to ask here is- when exactly do we say that a couple is infertile? They are said to be infertile only if they are unable to achieve pregnancy for 1 year despite having had frequent, unprotected sex. In the case of younger couples (below 35 years), this timeframe is 6 months.
•So, if you hear the term unexplained infertility, it simply means your IVF doctor has tested your fertility and your results are normal. This is actually reassuring, and you should count your blessings that your tubes are open and that the sperm test is normal. Would you be happier of your tubes had been blocked ?
•Of course there is some limitation to the number of tests that current day technology allows doctors to perform. Typically, infertility is said to be unexplained if:

The woman is ovulating regularly

Her fallopian tubes are healthy & open

Her partner has a good sperm count and the sperm motility is good

This is the standard on which we decide whether a couple has unexplained infertility . One in ten infertile couples will be labeled with this diagnosis.

Infertility Treatments

Even though our diagnostic technology has limitations, patients are happy when they realize that our therapeutic technology is far more advanced . Even though we cannot identify the problem, we can solve it by bypassing it.

I remind patients that the question should NOT be "Why am I not getting pregnant ? " Rather, it should be - What can I do in order to get pregnant ?" After all, no one cares about problems - we only care about results - about having a baby !

Tuesday, September 29, 2015

Patients who come to us for IVF treatment have a lot of questions ! They want to know why their sperm is of a low quality or why the fertilization rate was so low. If their embryos were A-grade, they want to know why they didn’t implant ; or why there is no improvement in their uterine lining even after treatment.

There are a slew of questions that come our way and in most instances, we have no answers to give them and so, the only truthful answer is – “I really don’t know”. Maybe the more appropriate answer would be- “ Medical science doesn’t know”; this is because when I tell the patient that I don’t have an answer for them, some of them doubt whether I’m competent enough and whether I am sufficiently well-informed.

Harboring Unrealistic Expectations

The truth is that patients tend to have extremely unrealistic expectations from their doctors. They want them to be the “fixers” and want the doctors to take the concern of infertility off their shoulders. Irrationally, they want a doctor who will be able to give them a 100% guarantee that he will be able to help them conceive and one who will confidently tell them that this is exactly what he will be able to do.

I would like to say here, that if a doctor categorically tells his patient this, it would be no less than a sham. Biological systems are complex and messy and there is no concept of having all the answers. Many doctors will get their patients to run numerous tests- this is how they make a “diagnosis” and also keep their patients happy that they are actually doing something. Sure, these tests do give us some answers; but most of the results are totally pointless and irrelevant to the IVF issue.

Doctors Should Come Clean

Since these doctors don’t really have any answers, they go onto a complete tangent and treat these abnormalities, losing track of the issue on hand. If you ask me, it’s much better to come clean with the patient and tell them that we don’t know. In the same breath, I’d like to say, that patients don’t need to go berserk when they hear their doctor say this.

After all, we aren’t researchers and don’t run a research institute; we are an IVF clinic that tries to help infertile couples have a baby. The point to keep in view here is that though we may not always know what the problem is, we have the knowledge, technical expertise and experience to craft solutions that allow us to bypass the problem, and this is really for the best.

I always tell my patients that the quality of my answers will be directly dependent on the quality of the questions they shoot at me, and if they ask pointless questions- the truthful answer from me will be- “I really don’t know”.

The Best Way to Battle Uncertainties

It’s important that patients recognize that their doctor isn’t fobbing them off with “pseudo answers”. The undeniable fact that we all have to deal with is that life is riddled with uncertainties and IVF is no different from any other fields, in this respect. The minute we learn to accept this fact, it will become significantly easier for patients as well as doctors to deal with this in a level-headed manner.

When a patient asks me a question, I sometimes deliberately say, “I don’t know the answer, let’s look it up.” I’ll deliberately do a search for them, and go to a curated and reliable website, and we’ll read the answer together.

Doing Things Differently

This is antithetical to what I was taught at medical college and it was hammered into us that just as treating a patient is important, so is instilling confidence in them. And some doctors follow this dictate in a blindfolded manner and pretend to know everything there is to know. But as Abraham Lincoln said- “You can fool all the people some of the time, and some of the people all the time, but you cannot fool all the people all the time”.

Some patients aren't too happy with my answer, because they don't like being treated by a doctor who doesn’t have all the answers; however more mature patients appreciate the fact that I am being honest with them.

Monday, September 28, 2015

One of the first things that I tell couples when they come in for a consultation is that infertility is something that either the woman or man can suffer from. Unfortunately in our country, with the male-dominated society we live in, when a couple is unable to get pregnant, hardly anyone including the woman herself think that the problem may lie with the man.

The Test

The fact is that the problem can lie as much with the man, as it can with his wife or partner. Here is the standard testing and treatment procedure we follow when we are testing a man for infertility.

•We start with a semen analysis
•The patient has to provide semen for testing- this may be collected in the lab or he can collect it at home, but will have to ensure that it is brought to the lab within an hour after it has been produced
•This sample with then be analyzed to check whether there is sperm present in it
•A sperm count will also be performed ; if this is found to be less than 15Million sperm per milliliter or semen/ if the total sperm count is less than 30-million/entire ejaculate, its considered to be a low sperm count
•The technician also analyzes what the motility (movement) of the sperm is like and whether they are of normal shape

There are different problems that can be present in isolation or it may be a combination of problems that is causing infertility, such as:

•The sperm may not be moving well - low motility
•The sperm count may be low, but all of them may have good movement- low sperm count
•There may be no sperm present at all – azoospermia
•There may be sufficient sperm with good motility but a large percentage of the sperm may be abnormally-shaped- abnormal morphology

The semen analysis results help us ascertain which treatment options will be most suitable to the patient.

For men with a low sperm count or poor motility, IVF/ICSI is usually the best option.
For men with azoospermia ( zero sperm count), we need to use additional procedures, such as TESE.

If we don’t find any sperm after the TESA/TESE procedure, we recommend that our patients opt for donor sperm or consider adoption. Regardless of which option the patient decides to opt for, we provide complete guidance and support to the couple.

Want to confirm you do not have male factor infertility ? What's your sperm count ( million per ml) ? sperm motility ( percentage) ? grade of motility ? morphology ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!

Sunday, September 27, 2015

IVF is expensive, and you need to make sure you select the right doctor to maximise your chances of getting pregnant in your first IVF cycle.
We all know that not all IVF clinics are created equal, and that success rates can vary widely from clinic to clinic.
How can you make sure that the clinic you select is technically competent ?
You only need to ask one question - Do you provide photos of IVF embryos ?
All good clinics do this routinely and proactively.
After all, the only tangible product an IVF clinic can deliver is embryos ! Once the embryos are transferred, we have no control over the biological implantation process.
Seeing that your clinic has made good embryos for you can reassure you that you have received high quality medical care !
A picture is worth a thousand words - especially when it is one of your IVF embryos !
Need help in getting pregnant ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you !

Times have changed and increasingly, women are making a concerted choice and pushing child-bearing onto the backburner, and are focusing on their careers. The corporate world can be very unforgiving in the way it makes demands on women, in terms of the time and effort they are required to put into their work- this is now causing an increasing number of women to postpone their baby plans well into their 30’s.

The Problem

At a cursory glance, this doesn’t seem like a significant shakeup. A woman who would have typically had a child in her late 20’s will now have a child while she is in her 30’s. But the fact is that even as she focuses on her career and pushes ahead motherhood, her biological clock continues to tick; with increasing age, there is also a drop in her ovarian reserve and that drastically reduces her chances of getting pregnant when she finally decides the time is right to have a baby. This can be a huge price to pay.

The Solution

Fortunately, now women don’t have to be torn between their desire to pursue a career and to have a baby. Opting for IVF can help them have the baby they want, when they want it, without having to stress over whether they are missing out on building a successful career. At our clinic we have treated several patients who were in their late 30’s, many of whom didn’t realize that while they focused on their career, their eggs reserve were dipping too.

Similarly, we also treat a lot of career women who have made a very well-informed decision about deferring motherhood. They have made a conscious choice in opting for IVF. In fact, many of them may have gone ahead with furthering their career prospects, comfortable in the fact that they will be able to have the baby they want, even later in life.

Delaying motherhood can actually be a smart decision. It’s a proven fact that older women make better mothers, because they are more mature and financially more stable too. This gives them the opportunity to provide for their child in a much better way. They are making a well-informed choice. While this may be unconventional , these are professionals who know their own mind and are used to making their own decisions !

The First Choice

I would like to take this one step further and state that IVF should actually be the first choice of couples who want to have a baby later in life. It’s a proven treatment with success rates that are higher than that of any other infertility treatment.

Today, egg freezing is another option that a number of women are considering. In this procedure, the woman’s oocytes are cryopreserved when she is in her 20s or early 30s, to be used at a later stage when she is ready to start her family. This particular technology has been around for a very long time; however it evolved in a big way only in 2009 when the process of vitrification was introduced. Now, the success rates of IVF using frozen eggs are in-line with IVF using fresh eggs. This option allows women to have their cake and eat it too !

What Global Corporations are doing

Global corporations like Google and Facebook have also begun giving their female employees the option of egg-freezing. It helps them retain talent within the organization and the women who opt for it, are able to concentrate on their careers without the sword of infertility hanging above their heads. Some women also opt for egg freezing because they just haven’t found the right partner to have a baby with.

Regardless of which way you look at it, IVF and Egg Freezing are procedures that are no less than a boon for all those career women out there who felt that they never had a choice. In the 1950s contraception allowed women to plan their families, so they could decide how many babies to have and when to have them. Now, reproductive technology empowers them even further, so they can make the right life decisions for themselves. Biology is no longer destiny, and women can compete with men on equal terms, without having to worry about their biological clocks !

Saturday, September 26, 2015

Most infertile couples are confused about whom they should visit when they require medical assistance. It’s true that both the man and the woman get affected by infertility, but it’s typically the woman who is proactive with seeking medical care. Most bypass their family doctor, but they aren’t too sure about whether they should consult a gynecologist or an infertility specialist.

There are certain advantages and disadvantages to both these options and its worth looking at what these are.

The Logical Choice

The first logical choice is obviously the gynecologist and most women also have a long-standing relationship with him and are more comfortable with approaching him. Since these specialists tackle women’s health problems, most of them are competent enough to quickly recognize when infertility is the issue. However , they are very conservative in their approach and are typically the first choice for a simple problem, however:

•When it comes to dealing with any complex infertility issues, they have neither the knowledge not the skill to provide the right advice or treatment
•Since they are out of their depth, they tend to subject the patient to different and totally unnecessary surgical procedures such as laparoscopy
•When they are dealing with men with low sperm counts, they will perform IUI (Intrauterine Inseminations), simply because that is the extent of their skill
•They are also completely lost when it comes to handling male infertility problems and these patients will automatically be referred to a urologist . This also means that your care gets fragmented and results in being of poor quality
•Another major issue is that most gynecologists aren’t sufficiently aggressive while dealing with older women. Since a majority of their patients are fertile, they fail to keep in view the fact that age impacts the ovarian reserves of older women and can lead to infertility
•Apart from this, they aren’t particularly interested in treating infertility
•Their waiting rooms aren’t really infertile-patient friendly. There will be many expectant mothers and this is definitely a distress point for the infertile women who have come to consult the gynecologist
•Many of these specialists aren’t even empathetic or compassionate enough when they are dealing with infertile patients; they fail to see the emotional impact that infertility has on them

If you have a complex problem, an infertility specialist should be your first choice- they are experienced and have the expertise to deal with infertility, and will solve most of the problems with the use of advanced reproductive technology. But the other fact to keep in view, is that they are also quite expensive; some of them will also include complex, and unnecessary treatment that is very expensive, even when it isn’t warranted. All these aspects leave patients in a quandary and they aren’t at all sure which specialist they should approach.

What we do in our Clinic

•If I’m the first doctor the infertile couple is consulting, I complete the workup for them- this gives us an idea about what is causing the infertility
•This takes 7 days to complete and costs around Rs 6000 only
•In case the problem is a simple one, we recommend they consult a gynecologist for their treatment.
•This allows us to focus on infertile couples with complex problems and the quality of care we provide isn’t diluted in any way

Take Control of Your Treatment

In an ideal world, gynecologists should be taking care of all the simple problems; in case the couple fails to achieve a pregnancy within 6 months, they would then refer these patients to an infertility specialist. But that’s not how things typically work. Since most doctors have a proprietary attitude towards their patients , they are reluctant to refer these patients to infertility specialists; after all which doctor in his right mind would want to lose his patient?

But the patient is the one who stands to lose- money, time and energy ! One useful tip is to create a clear plan of action with a well defined timeframe in partnership with your doctor. This will give you a very clear idea about what your treatment options are; it will help you hold the reins of your medical treatments as well as your life, and it gives you peace of mind that you have done your best.

Friday, September 25, 2015

It’s natural for human beings to worry, and infertility is one experience that lends itself very easily to it. Regardless of how much we counsel our patients, they do tend to worry- some of them, a little bit, while others, quite a lot. It’s natural for them to do so, simply because there are just too many aspects of infertility which can cause them to ask questions like:

•Will the treatment work for me?
•Will I be able to afford it?
•Are the injections going to hurt?
•Will I be able to survive the 2WW?
•Will my husband/partner be supportive and understand what I’m going through?
•Are there any side-effects to IVF?
•And of course the biggie- What if this doesn’t work for me at all?

The Worry Factor

It's very normal for patients to worry and there are a number of reasons why they do so:

•They want to find a solution to their problem
•They want to prevent themselves from missing an important detail
•Nobody wants to be surprised by anything negative
•They want to be prepared for the unexpected

It’s okay to worry only up until a certain extent. In some ways, it can keep you grounded and helps you maintain realistic expectations of your IVF treatment- in this sense; worry can be constructive. Contrastingly, we also see some patients who worry so much and dwell only on negative outcomes; this makes them feel that they aren’t able to tolerate any kind of uncertainty.

Common Questions

Some patients ask me questions like:

•Why is this happening to me?
•Am I going to be the only one who will never have a baby?
•If we find that there are no productive follicles in this cycles, will IVF work for me at all?

There are a number of other questions that crop up in the minds of patients. But IVF can sometimes be a long drawn out process and if you are continuously worrying almost every day, week after week, it’s bound to cause you a lot of distress. As a matter of fact, it can also impair your ability to function normally in your daily life. If this is happening with you, it’s important you don’t ignore it.

The Right Perspective

Here are a few ways in which you can reduce the impact of negative thoughts and worry:

•Mind-Body Techniques- We do encourage our patients to practice mindfulness, meditation, deep-breathing techniques and yoga as well as guided imagery. These techniques help you calm your frayed nerves and you are able to think more logically and clearly

•Prioritize self-care: It’s no secret that we should always take good care of ourselves; however when you experience a profound stressor such as infertility, remembering the basics can be quite a challenge. You should prioritize eating healthy, exercise regularly, drink plenty of water and get sufficient sleep & connect with your partner meaningfully. This becomes the foundation that allows you some additional emotional energy to manage infertility-related stresses in a better way

•Therapy- Though you may not feel you need it, having a confidential place where you feel heard and you can get your feelings out, is very important too. You can look for a counselor; or find support online as well. Our expert patient, Manju, who runs a blog at myselfishgenes.blogspot.com
can be very helpful !

Worry is a very normal response to infertility, but it’s not normal to let it consume you. Don’t let worry weigh you down on your IVF journey; simply try these techniques and send worry a-packing!!

Thursday, September 24, 2015

Finally our journey towards becoming parents has begun. We are very very thankful from bottom of our heart to Dr. Malpani and a very close friend who suggested his name. He helped us all through our painful days and shares a major part in making our dream come true.

We had been trying since 3-4yrs and were unsuccessful because of blockage in one of my fallopian tubes and I had lost other in ectopic pregnancy. We tried our first IVF cycle with another doctor but it failed. I was told that I would never conceive with my own eggs. That moment was worst worst worst of my life when I felt like I did something wrong so these things are happening to me. Everyday used to curse myself that had I known this possibility I would have taken care of my health in every possible way. I never had any symptoms of tubes blockage and my periods were very regular still how I can not conceive with my own eggs.

Thanks to my friend who really pushed us to try for Dr Malpani and we will be thankful to her all our life. A very important thing happened when I first met Dr was- he gave us hope and it gave me lot of strength to face entire treatment with a positive attitude.

So I will suggest every couple who is facing same problem please go and meet him once after that you decide but don’t be prejudiced before talking in person to him. Today we are going to have our own baby. One more advice is please do not call yourself “infertile” this word is very depressing and makes you hopeless. Today technology has evolved so much that anyone can become a parent. So please don’t stress out yourself considering “infertile” and have faith in GOD, you will be directed to good doctors like Dr Malpani. It’s GOD’s way.

Couples who are trying to conceive are instructed by their doctors to have timed sex. Apart from the fact that IVF treatment can take a physical and mental toll on patients, the one major fallout is that their sex drive takes a distinct hit. Before they started trying to conceive, sex was something they looked forward to and hopefully, it was a passionate way in which the couple would connect with each other.

Many couples also feel that when they eventually decide they want to have a baby, their sex lives get a little more thrilling as they don’t really have to worry about contraception. But as the days go by and the pregnancy test comes back negative, all of this changes. Though not many patients discuss this very openly during a consultation, some do ask me why it is that they now feel like sex is a chore?

The Reasons

If you feel that your sexual drive and your relationship with your partner have deteriorated, just know that you’re not alone. Take a look at how this occurs:

•Sex Becomes Frustrating- When you are attempting to get pregnant, sex becomes a source of frustration; it’s a constant reminder of the fact that things are not working out the way they should have. This is how sex transitions from being a “stress reliever” to being the reason for the stress.

•Having Sex Feels like a Chore- Sex during infertility is something that couples have to do to achieve a goal (one which seems like it’s impossible to achieve). When your doctor tells you to have sex on certain days and you have to time it for ovulation, it makes couples feel like they are told to complete some homework, rather than feeling like they are connecting with each other.

•A Matter of Shame- Often, couples who are dealing with infertility confront feelings of shame- they feel unworthy of being attractive to their partner. Many women feel that infertility makes them feel less womanly and their bodies don’t feel attractive any longer- as they feel that they are “damaged” by infertility. Men too are impacted by the situation and it can impact their feelings of masculinity. Women tend to get depressed, while men struggle with feelings of shame.

•Anxiety & Depression- These are very common in couples struggling with infertility and it takes a toll on their sexual relationship. Anxiety leads to sexual tension and depression results in a lower sexual desire.

•Sexual Dysfunction- Studies indicate that both, men and women with infertility are much more likely to suffer from sexual dysfunction compared to their fertile counterparts. This refers to having problems at any stage of having sex. Men can also end up suffering from erectile dysfunction, premature ejaculation as well as performance anxiety.

The Bottom Line

The stress of attempting to conceive, infertility diagnosis, the tests as well as IVF treatment often leads to tension in a couple’s sexual relationship. The good news is that this doesn’t mean that the situation continues to stay that way forever. Once the couples succeed in getting pregnant, opt for adoption or choose to remain childfree; over time, their levels of marital & sexual satisfaction can improve to a great degree. So, even if things seem a little tough at the moment; once it’s over as it eventually will be- things will get better.

Wednesday, September 23, 2015

The V.I.P. Syndrome in medicine occurs when influential or powerful people receive special treatment, such as hospital rules and regulations being bent to keep them happy. Not only do VIPs demand and expect deferential treatment, most of us have been conditioned to provide them with this and doctors are quite happy to toe the line. Touting the fact that you are treating a VIP can be a major ego boost for doctors, and some will "leak" this to the media as a publicity stunt in order to attract more patients. Doctors compete for the attention of VIPs, and many play a game of one-upmanship when a VIP is hospitalised, because they want to show that they were selected as his doctor of choice. Many bend over backwards in order to keep the VIP happy for their personal selfish reasons ( for example, because they want a promotion). Others do it out of fear, because they don't want to be punished for failing to satisfy the VIP's whims.

VIPs include: politicians in power ; the uber-rich , who are used to buying privileges; and celebrities. Interestingly, senior doctors can also suffer from the VIP syndrome when they fall ill, because their colleagues and juniors treat them with respect and kid-gloves.

Not all doctors like treating VIPs, and some even resent them. They are often “difficult” patients , and it can be humiliating when such a patient ( who thinks of himself as being a "big shot") treats a health care provider with contempt. Taking care of VIPs is not a bed of roses, and being subservient is not good for the doctor's self-respect.

Ironically, the VIP syndrome can be bad for VIPs as well ! Too many cooks spoil the broth, and the quality of medical care for these VIPs often suffers because there are too many consultants jockeying for control. Also , these medical decisions are subjected to the harsh glare of publicity, which is why the doctor overthinks them, and often ends up overtesting and overtreating the VIP to protect himself. A major risk is that if the VIP dies, the doctor's reputation takes a beating , and angry mobs have been known to beat up doctors and even burn hospitals down.

Dr. Walter Weintraub warned doctors way back in 1964: “The treatment of an influential man can be extremely dangerous for both patient and doctor.” Physicians “afflicted” by V.I.P Syndrome violate the basic principles of social justice and equity , which are the bedrocks of medical professionalism. For example, some doctors allow an influential politician's relative to jump the queue and go to the head of the waiting list for kidney donation . When these facts come to light, this causes heartburn and resentment amongst other patients. Lots of doctors cave in to political pressure, and these bad apples corrupt the system. This is unethical and unfair, because patients should be triaged and treated according to their medical problem, not their social status. The VIP syndrome is not restricted to India, but is much more prevalent here, because politicians are used to getting their own way!

The truth is that most VIPs want to be treated as regular patients because they know that being star-struck can impede the doctor's medical judgment. They actually admire the rare doctor who has a backbone and treats them the way he treats all his other patients, because they are smart enough to respect professionalism when they encounter this. Drs Mariano and McLeod offered three directives for caring for VIPs:• Vow to value your medical skills and judgment • Intend to command the medical aspects of the situation • Practice medicine the same way for all your patients.

Many wise doctors go out of their way to treat their poor patients as VIPs . While they may not be able to grant you favours, they can shower you with their blessings - something which mature doctors value because they focus on the emotional income which medical practise provides them. This is why doctors continue to admire heroes like Albert Schweitzer , who treated all his patients as VIPs .

There are a number of factors that infertile couples have to take into consideration when choosing an IVF clinic. One of the most important criterion should be the clinic’s success rate- the doctor’s competence with making babies. However, consider a hypothetical example- Suppose you have a choice between 2 clinics that have similar success rates; one, a large IVF clinic that’s part of a hospital and the other, a standalone one; which one would you pick?

I’d like to come clean at this point and state that I’m admittedly biased on this one; but here’s why I feel that it’s best to do IVF at a smaller clinic:

IVF is a Medical Problem not an Illness

IVF is different from most medical treatments. Infertile couples are not patients – they simply have a medical problem; they need medical assistance in order to have a baby. Since most doctors are employed by and work in hospitals, it also means that they find it more convenient to provide care in a hospital setting. However, in no way does this prove that the quality of medical care delivered in a hospital is better than that provided by a standalone IVF clinic.

However, most patients still associate medical care with hospitals and that’s where they will head when they want IVF done. Their perception is that it’s a much safer place for their treatment. They feel that in the event of any complication, the hospital would be more competent at handling it. What patients forget is that hospitals are primarily designed to deal with ill patients; they aren’t geared at providing care for infertile couples.

Some Considerations

The problems & disadvantages of opting for IVF treatment at hospitals are:

•Red Tape- Infertile couples find themselves waiting in serpentine queues along with a whole lot of other patients
•Hospital bureaucracy (for billing and admission & discharge) can be a pain point
•Because the chances of complications with IVF treatment in a good clinic are so low, the ability to take care of complications is more of a theoretical benefit
•Large hospitals can be ultra-sterile, uncaring and icy in their dealings with patients

Why opt for Smaller Clinics?

•Small clinics are much more focused on caring for infertile couples. It’s because they specialize only in providing IVF treatment- that’s all they do!
•This also means they have honed their skills to perfection
•Not only do they provide excellent medical care; but also have various systems in place to provide emotional support and handhold the patient through the course of their treatment
•Smaller clinics are definitely warmer in their approach to their patients
•It’s much easier for couples to establish a personal equation and rapport with the staff members here
•It's far easier for patients to get their problems resolved, because they don't have to go through layers of hospital bureaucracy

Some More Reasons

Standalone IVF clinics are also much more responsive to infertile couple’s needs, because their very survival depends on delighting their patients (unlike hospitals that have many other departments, including cardiac surgery/joint replacement etc that are more glamorous and profitable). They are also much more cost-effective and efficient, because they do not have to deal with bloated administrative overheads.

Of course, all large clinics are not bad; and all small clinics are not good. You need to be discerning and invest time and energy in doing your homework before selecting the clinic which is right for you.

Not happy with the attention you are getting from your IVF clinic? Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!

Tuesday, September 22, 2015

My father has founded and funds an orphanage/ shelter for street boys in Nallasopara for the last 9 years. There are now over 45 kids - and 4 are ready to graduate, since they have completed their 10th Standard examinations. Not only has he constructed the building which houses them, he also takes care of their education !

Interventions in early childhood are the most cost-effective way to address societal inequalities while increasing overall economic output. My father inspires me to follow in his footsteps, which is why I am an angel investor and fund social impact startups.

IVF is a complex enterprise, and when there are so many moving parts, it’s inevitable that mistakes will creep in. When IVF doctors make a mistake, they find it very hard to acknowledge the error. Doctors do their level best not to make mistakes; and so when they do slip-up, their first reaction is to justify/blame someone/explain away what happened (just like everyone else does). The common justifications you will hear are- “It wasn’t my fault that this mistake took place, my nurse/assistant made it.”

The simple fact is that everyone just wants to keep their self-esteem intact and doctors harbor egos that need tending; this is why it becomes very difficult for them to acknowledge that they are human and can err. Doctors consider themselves to be in the helping profession & they want their patients to get better.

Doctors Have their Reasons

And when they commit mistakes that end up harming their patient, they are riddled with guilt and find it very difficult to live with this bitter truth. The only way they can prevent cognitive dissonance is to refuse to accept the truth; they will go to the extent of hiding the fact from themselves too. The reasons doctors try to cover-up their errors are:

•They fear that the minute they own up to it, their colleagues will think poorly of them
•They feel that they will have degraded themselves in the eyes of their juniors and staff members.
•In addition, they also have the sword of legal consequences dangling over their heads all the time. There are some patients who will take legal action against their doctors if they find that an error has been made
•Doctors have also been brainwashed by their professional liability insurance companies, risk management companies as well as hospital management professionals and lawyers that they should never confess to having made an error. They are told to zip their lips and not even consider apologizing to their patients. Their lawyers are concerned that the minute doctors acknowledge that they have committed a mistake, that will go against them in the court of law
•The other thing that doctors fear is that if they tell their patient that they have made a mistake, they will lose the trust of their patient and that it will impact the doctor-patient relationship

Owning up to Mistakes

And so, the very first response that doctors have when they commit a mistake, is one of denial. It’s important that doctors learn to be open and honest- with their patients as well as with themselves. This will help them do something constructive about it – this minimizes the harm caused by the error and gives them the scope to take measures that will prevent these errors from occurring in the future.

It is the one way that the healthcare system can be set on the right track. The burden of guilt and shame that the doctor carries if he doesn’t own up to his mistakes can only worsen over time. Doctors should keep in view the fact that many patients can be quite forgiving and a number of them will accept the fact that honest errors had been made. But they will not pardon the doctor if he adds insult to injury by attempting to bury these mistakes under a cloak of lies.

Are you worried that your IVF doctor made a mistake and is not being upfront about it ? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you better!

Monday, September 21, 2015

Our story... to being with....is no different from many infertile couples. A perfect love marriage in 2005 with everyone's blessing after 5 years of courtship !

As we began this exciting journey of togetherness, at age of 23m, conscious decision was made not to start a family until be both settle well in careers, have a house of our own and descent earning to support a good standard of living. Years passed by fast and we were all set by 2009 to begin 'trying' for a baby with a confidence to be conceiving soon.....

Came 2010 with no success after trying for a year almost. The doctor in me alerted my own self that something is not going right. Went to seek a gynaec opinion and was taken aback to learn that I had PCOS (polycystic ovaries) with anovulatory cycles which needs to be treated before we could try again. 6 months of treatment and the cycles were responding well. Started off with my ovulations studies and then the saga of trying 'normally' for 6-8 months. Again no luck ! Meanwhile, during this process, further good news for me was to learn that I am a thalessemia minor (a type of anemia) and grade 1 heart disease - MVP. And being a medic, I knew what this meant for me - conceiving will be a challenge and pregnancy will be high-risk. So I was referred to the so called experts in infertility in the town (Pune). Hysteroscopy confirmed everything normal and IUI suggested. 5 failed IUI cycles left us with 'IVF' thrown as the last option to conceive. By this time, all possible pujas, stone wearing and offerings at temples began under parental guidance with us resorting to it due to the insecurity of the creepy thought, ' What if we don't conceive' !!

Started the first IVF along with 40 other patients at a IVF center in Pune (literally felt like visiting a baby making factory), and after goggling all the positive IVF stories and being inspired by them, we began the journey of innumerable pricks both physically and emotionally (this part was far more painful). On the day of pick-up the the center expert comes and inform me that the process cannot go ahead as my eggs were poor quality and I will need to go for egg donation as she feels I would not be able to produce viable eggs. Shattered with the failure and top of it the daunting words of the center head rather than being encouraging - were the perfect recipe for going into depression. I gathered myself next day and went through the literature and reassured myself that 'I must not loose hope'. we waited for 6 months and repeated another IVF with the same center (because we had paid for a combo deal !!!). This time the so called 'supposedly bad quality' eggs managed to go to the level of ET and then the killing 2 weeks wait....just to see a negative result !

We lost all hopes, less because of failure and more because of the 'business minded' IVF centers all around, interested just in mending money without any humanitarian approach or sympathy toward their patients.worst part is that they follow 'one shoe fits all' approach with their treatment. For them, patients were clients and IVF was just a business. We decided not to go ahead with any more IVF tortures and take a brake mentally from all this and think on the lines of adoption later.

Dec 2013, I met another doctor colleague of mine and was discussing this experience with him. He took out his 1 year old daughter's picture on mobile and showed it to me. I just kept looking at her twinkling eyes and innocent smile and said - Oh what a cute baby! He then informed me about their experience with Dr. Malpani from Mumbai and how they succeeded in their first attempt to have this cute angel in their life. What really struck me was, my friend's comment - 'You won't feel cheated even if the procedure is a failure, just go and meet him once'. After a week of hesitancy to go through it all again, I checked their website which was pretty impressive in terms of the 'effort' taken to 'explain' the science of IVF to a common man. Their section on 'knowledge center' and IVF comic were a brilliant form of patient engagement in educating them on the various aspects of IVF. I picked up my laptop and wrote an explanatory email to Dr. Malpani with my case details. Got busy with my daily routine thinking he will reply in some days. I was pleasantly shocked to see his detailed email the same evening with some great suggestions with no urge to come and meet him for a consultation (like what you experience with a lot of hospital into e marketing) . After this we kept discussing on email for next 4-5 months before we went to meet him personally in June 2014. We went there with a very open mind and absolutely no expectations.

The clinic was very atypical of hospital/fertility centers and had a very positive environment. The staff was extremely courteous and empathetic. While we were waiting for Dr. Malpani to arrive, we were just glancing through the feedback book and what caught our attention was a feedback from someone who could not succeed with the IVF. He had written a lot of good things about the Malpani couple and the clinic and expressed a desire to come back again when they think of taking a chance again. And then came our turn for consultation. The best part of Dr. Malpani's consultation was his frank advise - Have your plan A, B and C ready. Success is not guaranteed. People make a mistake of investing their entire money and emotions into the IVF thinking this is a guaranteed success. And that's where we probably went wrong in the first 2 attempts. He did a detailed study of my reports and informed us beforehand that the treatment followed will be different than others and will be twice expensive as I have very low AMH counts (lesser number of eggs than normal females) and wrote us a list of medicines to be taken in case we plan to go ahead with his treatment. We felt relieved that someone is ready to understand us as a patient and tailor make the treatment to get the best results out of us. At least there was an intention to do the best possible and see success with my eggs, by Dr. Malpani, unlike the previous clinic experience.

I walked out of the clinic with a 'HOPE', huge peace and a firm belief that 'He (Dr. Malpani) can surely get the best eggs out of me'. Sounds funny, but after having thought of only eggs and sperms and their quality, failure et cetc for 4-5 years, you literally start considering yourself a hen in a poultry farm, producing eggs every cycle !!! haha....

August 1st 2014 we began the IVF with Dr. Malpani. We used to travel Pune to Mumbai daily on the day of visits. The entire treatment period was a roller coaster ride with my body responding differently at every visit. Finally came the day of 'pick-up' when Dr. Mrs. Malpani informed me with a sweet smile as I woke up from anesthesia that I have produced 11 good eggs !!! On the day of ET, Dr. Malpani did the procedure with a great positivity in the OT and asked us to hold hand and remember our prayers while he transferred the embryos. After the procedure I asked him the commonest query, do I need to be on bed rest? And he smiled at me and said. 'the embryos do not fall out, so just chill and both of you spend some good time for next 2-3 days'. We did follow his advise seriously !

The next 2 weeks wait was a killing experience, but we were sure to have a next cycle repeated after 2 months with Dr. Malpani again, if this fails. And the MOST pleasant surprise of my life was, a positive Beta HCG test received on my email at 6.25 pm on 25th Aug 2014. Our HOPE had finally converted into a 'LIFE'. It left eyes wet, hearts overwhelmed with joy and soul filled with gratitude for the Dr. Malpani and his entire staff.

The journey of pregnancy was a great experience and Dr. Malpani was always there to address any advice we would seek. Today I hold my 4 months old daughter in my arms...spending endless hours admiring and kissing those little feet, hands and forehead....and thanking God for routing us to the blessed hands of Dr. Malpani.

If God has chosen me to experience the joys of motherhood again, and if it has to be an assisted reproduction, Dr. Malpani Clinic is the only choice we would have in mind !

Women who are struggling with infertility are always researching and looking for information that will lift the mystery behind their infertility, and anyone who’s looked will know that it isn’t difficult to find information. The only problem is that you can get snowballed by it and will find it difficult to shovel yourself out of it all. That’s the Internet era for you. This is something the 21st century has brought to us, just as it has brought us fast lives and workplaces that operate 24/7, 365 days a year.

What isn’t so tangible is that it has also brought with it the growing problem of infertility and in many ways its linked to our lifestyles - food we eat or don’t eat; the fact that most people refuse to recognize that something called exercise exists ; and that there is no light at night, because that’s when human beings were typically meant to sleep, are all becoming factors that affect fertility.

A Sleep-Deprived Generation

Today, most young people don’t manage to get their 8 hours of beauty sleep. If you don’t get at least 7-8 hours of sleep at night, it will affect your mood, health, hormones - and your fertility. And today, IVF specialists everywhere are starting to sit up and take notice of this fact.

Sleep is Good for Your Body

While we are catching our 40 winks, our bodies are going through the motions of repairing cells as well as regulating hormones. Leptin is the special hormone that is the main link between sleep and fertility. It affects ovulation and it’s important that women get adequate sleep to ensure proper leptin production.

Lack of sleep also affects the production of hormones such as estrogen, progesterone, follicle-stimulating hormone (FSH) & luteinizing hormone (LH) all of which are connected to fertility in one way or the other. Any compromise on the production of these hormones can impact fertility in women.

Related Factors

With so many women working extended hours and on the night shift (which is infamously known as the “infertility shift”), insomnia is becoming another major factor that impacts women- it affects your hormones and can also age you faster than you normally would.

While the stress-infertility link is a widely debated one, the fact is that when women are diagnosed with infertility, it creates a tremendous amount of stress which has a further negative impact on sleep, mood and fertility, thus setting up a negative vicious cycle. When stress takes on a chronic form, it can impact sleep habits which in turn can worsen depression and anxiety.

The “Infertility Shift”

If you work nights, there is a distinct possibility that you will have a much tougher time getting pregnant. A number of studies have shown that women who work on night shifts have irregular menstrual cycles which can affect conception. This is because our bodies function on an internal clock- The Circadian Rhythm. Standard patterns of light & dark ensure that our Circadian Rhythm continues to function normally.

However working nights can send your Circadian Rhythm for a toss. It also controls the production of cortisol (stress hormone) and melatonin (the sleep hormone). When you keep all these facts in view, it’s not difficult to understand why and how lack of sleep can impact fertility. Very simply, if you work on the “infertility shift”, and are trying to have baby, first make a shift to a routine that will give you sufficient amount of sleep, at the right time.

Though this may be easier said than done, it’s a very important aspect that women who desire to have a baby, should not overlook or ignore. Be kind to your body and you will find that it reacts in a better way too.

Sunday, September 20, 2015

One of the biggest fears that any IVF couple has is that they may end up taking treatment at an IVF clinic where the doctor isn’t technically competent, or maybe they don’t have a skilled embryologist or their equipment may be ill-maintained and they may not be following the required quality standards. Some IVF doctors travel a lot and they are hardly ever at the clinic, and inexperienced juniors and assistants handle the work; which is another concern patients have.

These worries and concerns are normal, because most clinics wear cloaks of secrecy. You will find that most of their websites are very similar-looking; but patients should keep in view the fact that the success rates of the good clinics are far better than those at sub-standard ones. This is primarily why infertile patients don’t make hasty decisions when they are zeroing-in on an IVF clinic.

Make the Right Choice

Patients are aware that there are a number of variables in play and that the outcome of the IVF cycle isn’t something they have too much control over, but the one thing they can control is choosing the best possible IVF doctor. And so, while a patient can’t reverse the clock, she knows that by choosing a clinic that has good success rates, she will dramatically increase her chances of success, compared to another clinic that provides less expensive treatment; but has a lower success rate.

Making the wrong choice can be a gross waste of time and money, and it reduces the chances of the patient getting pregnant. So, how then do you judge the quality of your clinic? This can be a very difficult question. Just as doctors come in different shapes and sizes, every patient too is different from the next. They will have different needs and personalities and every patient has to find a doctor who is in-sync with her needs.

Things to Consider

The different aspects that you will want to consider are:

•Do you need a high-tech clinic that does a lot of cutting edge research?
•Do you want one that specializes in treating celebrities?
•Are you looking for one that has a high-touch, personalized approach?
•Do you want one which is the cheapest?

The one thing that isn’t negotiable is that your clinic should be willing to provide you photographs of your embryos. Regardless of how famous your IVF doctor is and how reputed his clinic, and despite how charming he is or how impressive his website; and no matter how many patients vouch for his competency, this is the one sine qua non of a good IVF clinic.

Why are Embryo Photos Important?

Essentially, the only thing that any IVF clinic does is create embryos in the lab. The quality of the embryos that the doctor can create for you is the determining factor in IVF success. Once the doctor transfers your embryos into your uterus, he has zero control over whether they will implant or not; since it’s an in vivo biological process.

But the fact also is that the better the quality of your embryos, the greater the chance of them implanting. The one stumbling block is that if an IVF cycle fails, it can be very difficult to determine the reason for the failure. When the clinic routinely provides you the photos of your embryos, it’s an indication that the doctor is confident about his skills. In addition, you have documentation in case your cycle fails and you require a second opinion.

The Hallmark of a Good Clinic

Typically, a clinic should give you photos of your embryo before the transfer; and if they don’t, you should be wary of them. Some patients worry that their doctor will get upset if they insist on the photos. But think about it this way- why would a good doctor be upset about something that is supposed to standard protocol? Only the bad clinics will get upset; but then those are the ones you should be staying miles away from, isn’t it?

Saturday, September 19, 2015

For infertile couples, stress and infertility challenges typically go hand-in-hand. With the stresses of modern day living, it’s not surprising that infertility is on the rise and 1 in 6 couples struggle with it. Many of the couples who come to our clinic are distraught; having gone through years of trying unsuccessfully to have a baby.

The Stress Point

While some of these patients may have tried infertility treatment in the past, many have tried nothing except timing their intercourse etc; which obviously has proven to be unsuccessful in their case. We also have patients with secondary infertility; patients who have one child but face infertility issues while trying to get pregnant again. Needles to say, their inability to conceive the second time around becomes a stress point. Many of these patients are trying to have their second baby much later in life and find that age isn’t on their side this time around.

Breaking the Grip

So how can patients break this tight grip between infertility and stress? The one proven way to do it is to include some OM or AUM in infertility. It means that the patient should widen her perspective just enough to help her connect with something that’s deeper & powerful; something that she already has in her being. OM is a very powerful word and popular for the manner in which it reverberates and makes you feel when you chant it. Today, it is used as a meditative technique, not just in India, but across the Western world too; it helps you focus your mind as well as your nervous system.

When you chant OM, you consciously align your mind, body & spirit. Many of my patients raise their brow when I tell them to learn and practice a bit of yoga and OM chanting while they are doing IVF. They wonder how meditation and medicine mix; well, the answer is simple- Technically, they don’t, but it’s a proven fact that the more you stress, the more your body misbehaves and no matter how much you try, you may not get pregnant.

Change your Perception

On the other hand, when you meditate and learn the OM technique, it helps you shift the manner in which you perceive yourself and your experience by integrating OM figuratively/literally; you automatically open yourself up to a mind-body perspective. When you do this, you are able to deal with your infertility in a much better way. Since your attention shifts to cultivating a deeper part of yourself, it’s easier for you to ease all the stress and anxiety out of your system.

The Mind-Body Technique

You will be able to get some space to breathe and will move through this entire IVF experience very differently. Alice Domar, is the brain behind this mind-body approach to deal with infertility. She has conducted a significant amount of cutting edge research that is focused on the connect between stress & fertility.

She started her research way back in 1987; studied the impact that physiological stress had on infertility. She has developed a range of mind body techniques that are effective in combating infertility-related stress. Today, most reputed IVF clinics offer have support groups that help women understand how they can change the way their bodies react to stress.

The Effective Tool to Combat Stress

The one thing I tell all my patients is that the infertility experience doesn’t really have to be so stressful and anxiety-filled. It’s natural for you to go through different levels of emotional stress while you are going through IVF treatment; integrating some kind of mind-body or spiritual aspect can help you focus your attention in a much more positive way.

It also helps you address your emotional responses in situations that are way out of your control. And so, OM can be a very useful tool for any woman who suffers from infertility and the anxiety and stress that is integral to it.

Need more information? Please send me your medical details by filling in the form at www.drmalpani.com/free-second-opinion so that I can guide you!

Friday, September 18, 2015

When infertile women make an effort to follow my advice and conduct IVF research online, most of them get thoroughly confused. Many just get lost in the Web because there is an ocean or two of information out there; and they just aren’t too sure about what they should be reading. What worsens this issue is the fact that they find diametrically opposite information on different sites and they don’t know which one they should trust.

They can’t make sense of what they read, and many just give up in frustration, preferring to take the path of least resistance. They believe that ignorance is bliss and that it’s best to leave everything to the doctor; the different thoughts that cross their minds are:

•After all, he’s the expert and isn’t this his job?
•Am I not paying him big bucks for his expertise?
•Why not trust him and let him make all the decisions?
•Why waste time trying to countercheck on them?

A Waste of Precious Time?

They feel that when they look for information online, it just eats into their time and in a way, corrodes their trust in the doctor. When they attempt to ask questions and get clarifications for their doubts, the doctor just tends to get annoyed, so what’s the point of going through this entire exercise in the first place?

It’s a fact that online information can be very confusing. If that’s what is happening to you, it simply means that the information you have chanced upon is of low quality and that is what makes it confusing. The only solution to the problem, is to not give up; just keep looking for good quality information till you find it. It’s simple – good quality information wont confuse, it will clarify!

Confused Doctors Translate to Confused Patients

A large portion of the information you find online isn’t trustworthy because it is tainted by a hidden agenda; everyone is trying to sell you something. Some of the information is poorly-written and dense, because the doctor who has written it, is confused himself and it’s no surprise that he ends up confusing the patient too. These same doctors will also end up confusing their patients during a consultation; and the patient is typically left with more doubts than answers at the end of her visit compared to when she walked into his consultation room.

Quality Information Shines

It’s the quality of the information and how it’s presented which will decide whether the patient who reads it will get confused or enlightened ! Just like a good school teacher can help to make even a complex subject like calculus fun and exciting; and a bad teacher can make any subject dry, dull and boring, doctors need to start learning how to teach. We need to adopt modern teaching tools , such as videos, e-learning and graphic comic books, to get information across to our patients .

Teaching Well is as Important as Learning Well

I tell my patients that if you find you are confused after visiting a website or after talking to your doctor, the fault lies with your doctor, not with them! If the doctor cannot do a good job, that’s because he doesn’t know how to teach! The good news is that now, there is a significant amount of high quality, well-produced accurate information available online, that patients can access.

Even better, if you are willing to be patient and take your time looking for a clearly written website, you will get better at understanding what’s happening to you during your infertility journey. Believe me, as you master the skills, it does get easier over time; and it can prove to be a very worthwhile investment of your time and energy !

Thursday, September 17, 2015

For anyone who’s on the “fertility train”, it can seem like there is only a way to get on and that there is no getting off it. Any couple that has faced infertility and gone through any treatment for it will know that the journey can be extremely frustrating, confusing and overwhelming to say the least. When the only all-consuming thought for you, is about having a baby, it’s not difficult to lose perspective of all other things that may be important too.

There are times when certain patients find me blunt in my approach, while others may feel I demand too much of them when I tell them to be well-informed and read up on the topic of IVF and specifically the treatment they will be undergoing. I tell them they shouldn’t be blindly taking medication and following their doctor’s instructions and that they should learn to question their doctors.

The Patient- Doctor Relationship

While most of my patients eventually do see the sense of my words, there are others who feel that I am not in-sync with their needs and feelings. This is not uncommon when it comes to a patient-doctor relationship and in many ways it is a very important aspect of the patient’s IVF journey. Making a decision to consult an IVF doctor requires a certain amount of courage; this is because, very simply, you are entrusting very personal goals of becoming a mother to a person who essentially doesn’t know you- your values, dreams and hopes.

Support on a Turbulent Journey

Of course, it’s important that a doctor be compassionate and warm and empathetic too; this is especially true when it comes to IVF treatment. Sometimes, IVF can be a long journey and it’s important for you to be sure that you are able to vibe well with your doctor. Here are a few attributes you should be looking for in your IVF doctor; it will help you ascertain whether he understands you:

•Value of Time- You may have been trying to conceive for several years before you set foot in an IVF clinic. Your fear may be that you have waited too long and you may feel defeated even before you start out on the treatment. After such a long wait, all you want is to get pregnant. Your IVF doctor should be able to schedule a consultation without delay, start out with the tests as soon as possible and tell you what options you have before you, without wasting too much time.

•Not one Who Says “Just Relax”- This is the last thing an infertile patient wants to hear. When you just don’t feel any closer to your goal of becoming a parent and you go through one month after the next disappointed with a negative pregnancy test, “relax” is the most difficult thing to do; and no matter who tells you to relax, it just stresses you even further. Your doctor should be able to give you a solid action plan and tell you to be good to yourself even as you struggle with your infertility.

•Recognizes that You Feel Social Pressure- When you’re attempting to get pregnant it seems like everyone you know is getting pregnant. Especially in India, it’s not uncommon for everyone from relatives to friends to pry and ask “So, when are you‘ll planning to have a baby?” Over time, this social pressure just builds up and your doctor should be able to empathize with you on this count.

•Gives No False Hopes – A good IVF doctor is one who will tell you to be realistic and who won’t give you any false hope. Keep in mind that though IVF is a very effective treatment for infertility, there are no guarantees and you should be wary of a doctor who tells you that with treatment at his clinic you will “definitely” have a baby.

•Gives You the Scope to Be You- IVF is nothing less than a rollercoaster ride and you will go through many challenging moments. There could be times when you need to scream, cry, challenge or sometimes, just go through the motions. Your doctor has to be able to understand that it may not always be possible for you to be positive, cheerful and optimistic; but he should be able and willing to support you through it all.

•Is easily Accessible- It’s true that IVF is not an emergency treatment, but a patient will, at one time or the other have doubts and qualms that will have to be addressed as soon as possible. Not all fears can be kept on the back burner till your next consultation. Though it wouldn’t be possible for a doctor to function efficiently if every patient would frantically dial his number when she had a teeny tiny doubt; it’s important that your doctor be accessible. Many a times, that is reassurance enough for a patient.

Your IVF doctor should understand that being a parent is important to you and that its part of your identity; the minute your doctor understands this, most other things fall in place. At our clinic we make sure that our entire team makes your experience a priority.

Wednesday, September 16, 2015

It’s very disappointing to see how clueless most IVF patients are about what happens in the IVF lab. Sometimes, as with any biological system, things do not work out as expected; for example, the sperm may just fail to fertilize any of the eggs (total failure of fertilization). In such cases, it’s important for the doctor to take responsibility and be transparent with the patient; this will help him troubleshoot the problem and offer a solution.

The Malady

Now comes the even more unfortunate part (that borders on the shocking) - most doctors are completely unaware of exactly what procedures take place in the lab. Sure, they know that eggs are fertilized and allowed to “culture” there, but their knowledge doesn’t go deeper than that. They are essentially clinicians who are trained as gynecologists; and all the lab work is typically left to the embryologist.

To a certain extent, this can be overlooked, if the lab also has a full-time qualified embryologist. However, most IVF clinics in India find that this is a luxury they can ill afford. These clinics just have to make do with the services of traveling embryologists or poorly qualified lab technicians. When it comes to lab procedures, every single step is crucial in achieving the desired result.

Inept Embryologists

Unfortunately, there are just too many inexperienced embryologists or very poorly qualified ones doing the rounds. They are able to manage the straightforward IVF cases; however they aren’t always able to work with challenging patients. For example, they may not have the ability or skill to handle testicular sperm and will simply tell the patients that it’s best for them to use donor sperm.

They will concoct a variety of excuses just to pull a cloak over their incompetence. Therefore even in instances when a patient has a large number of embryos to spare; instead of freezing them for her, they lie through their teeth and tell her that the pregnancy rates with frozen embryos are poor. They will then simply discard them or donate them to other patients.

Cloaking their Incompetence

It’s clear that the there is very poor documentation of lab protocols in these labs. If mishaps occur, they will be neither documented nor reported. A poor quality lab will never be able to produce good quality embryos and that is exactly what happens here. But the patient has no inkling of what is happening behind the confines of the lab’s walls and everything is kept under wraps. Before the transfer, the patients are given a cursory glimpse of the fragmented embryos under the microscope; they doctors claim that these are good quality embryos that are cleaving.

They don’t give patients a copy of their embryo’s photographs- this should be a red flag for patients as more often than not, it is an indication that the lab is poorly equipped or maintains dismal quality standards. They may have no power backup for the lab equipment and in case of a power failure (which is common in many parts of our country), the embryos will arrest in the incubator. However, this information too, is held back from the patient.

Gullible Patients

Sadly the poor patient bears the brunt of this gross incompetence. When an IVF cycle fails, the blame is often laid on “poor egg quality”. The patient is asked to look for other options, such as donor eggs. Most patients are naïve and since they are also ill-informed, many just accept their fate. Little do they suspect that the doctor has taken them for a ride. It is important that IVF patients empower themselves with Information Therapy and scram from such IVF scams the minute they notice anything amiss.

Tuesday, September 15, 2015

Just last week I got a call from one of my patients. She had recently undergone IVF and we had transferred a beautiful blastocyst (5-day old embryo). Just like a number of our well-informed patients, she had conducted a significant amount of research on the different infertility options including IVF. When she came to our clinic, it was obvious that she was well read and had been reading on the subject online. In the course of her consultation, she asked intelligent questions and I answered every one of them.

Eventually, we did IVF for her and as mentioned at the start, we also transferred one blastocyt to her uterus. Now she was back with a few specific questions- She asked me why we hadn’t used ultrasound while doing the embryo transfer. Her next question was- “Where were the embryos placed in the uterus?” and another one right on its heels- “Have you used the best technique, and if yes; how is it the best?”

I know a lot of doctors who aren’t too comfortable when their patients throw too many questions at them. But I like to take the opposite route and welcome every question that a patient poses. In my opinion, it’s a sign that she is well–informed and taking an active interest in her treatment. Of course, before the ET, she had been told exactly how the transfer takes place. At that point of time, there had been no questions, but now she did have this volley of questions and I was eager to answer them.

About Embryo Transfer

ET or Embryo Transfer is the placement of embryos in the woman’s uterus and is the culmination of the In vitro Fertilization treatment that takes place in this manner:

•The patient’s ovaries are first stimulated to produce a larger number or eggs (Ovarian Stimulation)
•The eggs are then removed from the ovaries (Oocyte Retrieval)
•They are fertilized in the lab with the patient’s partner’s sperm
•We let the embryos grow till the balstocyst stage ( embryo culture)
•We choose a good quality blastocyst and place it in the patient’s uterus

Every step in IVF is crucial in its own way and there can never be any slip-up on any one of them. However, the last step has to be done right and it is critical in achieving a pregnancy. Incidentally, it is also one of the factors which separate a skilled physician and the best IVF clinic from the rest of the pack.

Some Proven Facts

Over the last three decades, a number of ET techniques have been developed, with varying success; however certain things have been show time and again:

•Placing the embryo correctly in the uterine cavity can be the difference between a successful or failed IVF cycle
•Most IVF specialists agree that when the embryo is placed between 1 & 1.5 cm from the fundus (top of the uterus), it will help achieve the highest possible pregnancy rate
•Placing it too close to the bottom or top can reduce the chance that the embryo will get implanted successfully
•ET’s that are performed without any kind of trauma to the uterus are obviously the best option. The “difficult” ones or ones that cause any trauma to the uterine lining & cervix or cause bleeding, result in much lower pregnancy rates compared to uncomplicated, smooth transfers
•Cervical mucus can prove to be toxic to the embryos and it’s important that the IVF doctor use a “clean technique” as this improves outcomes

How Best to Perform an ET?

Just like a lot of other things in the medical field, this subject too, is a highly debatable one:

•A number of doctors use ultrasound, and so do we, when needed. This helps in guiding the actual placement of the catheter
•Some IVF specialists perform a “mock” transfer to evaluate the right pathway
•Some doctors perform a hysteroscopy in order to evaluate the uterine cavity and the cervical canal before they transfer the embryo

At our clinic we may use either an ultrasound or a “mock transfer” as we had in the case of this particular patient. This allows us to map the correct pathway and gives us a clear idea about where the embryos have to be placed. Some patients find the ultrasound procedure a little uncomfortable (it requires a full bladder & a probe has to be held very firmly to the patient’s abdomen) and we may end up performing a mock transfer instead.

Our Technique Works Superbly

Fortunately for this patient as well as many others that we have treated to date, our technique works well. I explained the entire process to my patient just as I have mentioned here. I told her that it’s possible to achieve a successful transfer without using an ultrasound. But very frankly the most credible explanation came today; the embryo we had transferred was growing as it should and has a strong heartbeat.

Monday, September 14, 2015

If you are considering doing IVF, you’re sure to have read that injections which help you to grow eggs ( this is called ovarian stimulation or superovulation) play a crucial role in the treatment. Most of our patients are pretty well-informed about the ovarian stim procedure, but they still want more clarity about how these work. The drugs used to stimulate your ovaries in IVF treatment are gonadotropins (hMG & rFSH), and are available in many different brand names.

The Questions

They have a range of questions for me including:
•Do they have any side effects?
•If I am ovulating, then why do I need these?
•Will they increase the risk of cancer?

The Facts

Here are some facts that will answer some of those questions.

•Hormones are Required for Normal Ovulation- In their reproductive years, women ovulate normally every month; this is why they also have regular periods. A woman is always born with all the eggs that she will ever have. The pituitary gland produces the follicle stimulating hormone. This causes very rapid growth in a group of follicles. Each month, only one egg matures and it’s released- this is known as ovulation.

If the egg gets fertilized and implants in the woman’s uterus, she becomes pregnant. If that doesn’t happen, the egg will be shed with the endometrium (the uterus lining), and she will have per period. After the age of 40, a woman’s periods start becoming irregular- this is called oopause/perimenopause. Over time, her periods will stop and if she hasn’t had her period for a year, it’s an indication that she has entered menopause. The average age that women reach menopause is 50 years.

•Age & Reduced Ovarian Reserve- There is a decline in fertility once a woman reaches 30. But it’s not just the quantity of eggs that reduces; there is a dip in the quality of eggs too. This is referred to as oopause. By the time women are in their mid-thirties, their fertility begins to drop and by this age, most won’t be able to have a successful pregnancy without the help of ART (assisted reproductive technology). Women with poor ovarian reserve also have a much lower chance of getting pregnant, versus those who have normal ovarian reserve (in that same age group)

•Medicine Dosage- Before you start on IVF treatment, your doctor first orders some tests- these check ovarian reserve and include a blood test for AMH level as well as an antral follicle count. On the basis of all the results, the doctor will then develop a treatment plan for you. The dose of injections used for superovulation is a critically important choice . While a good doctor can use his experience and expertise to select the dose which he thinks is right for you, this does involve some trial and error as well, because every woman is different.

•Ovarian Stimulation in IVF- The thing you need to understand here is that all your eggs aren’t created equal. We use ovarian stimulation in IVF treatment in order to stimulate your ovaries to produce more eggs. Once these are retrieved, they will then be fertilized in the IVF lab. Like I mentioned, not all eggs are the same and when we have multiple eggs, it gives us the opportunity to carefully select & fertilize only the high quality ones, for a positive outcome.

Testing and More

Your IVF doctor will also monitor you very closely when gonadotropins are being used in your treatment. Blood tests & transvaginal ultrasounds will be done to check how your follicles are developing. In addition, it helps us check whether you are at risj for developing OHSS (ovarian hyperstimulation).